Abstract
Alterations in cardiac and renal biomarkers have been reported in coronavirus disease 19 (COVID-19). We conducted a systematic review and meta-analysis to investigate serum concentrations of hydroxybutyrate dehydrogenase (HBDH), a combined marker of myocardial and renal injury, in hospitalized COVID-19 patients with different disease severity and survival status. We searched PubMed, Web of Science and Scopus, between December 2019 and April 2021, for studies reporting HBDH in COVID-19. Risk of bias was assessed using the Newcastle-Ottawa scale, publication bias was assessed with the Begg’s and Egger’s tests, and certainty of evidence was assessed using GRADE. In 22 studies in 15,019 COVID-19 patients, serum HBDH concentrations on admission were significantly higher in patients with high disease severity or non-survivor status when compared to patients with low severity or survivor status (standardized mean difference, SMD = 0.90, 95% CI 0.74 to 1.07, p < 0.001; moderate certainty of evidence). Extreme between-study heterogeneity was observed (I 2 = 93.5%, p < 0.001). Sensitivity analysis, performed by sequentially removing each study and re-assessing the pooled estimates, showed that the magnitude and the direction of the effect size were not substantially modified. A significant publication bias was observed. In meta-regression, the SMD of HBDH concentrations was significantly associated with markers of inflammation, sepsis, liver damage, non-specific tissue damage, myocardial injury, and renal function. Higher HBDH concentrations were significantly associated with higher COVID-19 severity and mortality. This biomarker of cardiac and renal injury might be useful for risk stratification in COVID-19. (PROSPERO registration number: CRD42021258123).
Keywords: COVID-19 severity; Hydroxybutyrate dehydrogenase; Mortality.
【저자키워드】 COVID-19 severity, mortality., hydroxybutyrate dehydrogenase, 【초록키워드】 COVID-19, coronavirus disease, Meta-analysis, Inflammation, Biomarker, Mortality, severity, disease severity, systematic review, Sepsis, heterogeneity, renal function, meta-regression, risk stratification, serum, myocardial injury, survival, Patient, estimates, Admission, moderate, non-specific, COVID-19 patients, hospitalized COVID-19 patient, marker, Liver damage, Concentration, Analysis, Injury, Web of Science, standardized mean difference, 95% CI, tissue damage, alteration, effect size, renal, hydroxybutyrate, survivor, SMD, Myocardial, non-survivor, performed, significantly, reported, conducted, searched, magnitude, significantly higher, certainty of evidence, Egger, 【제목키워드】 Meta-analysis, systematic review, meta-regression,